Ethics & Law Practice Questions

Question 1

A 49-year-old woman with widely metastatic cervical cancer is dying in hospital. She has capacity and pain is well controlled. She specifically requests that her elderly mother, who lives abroad and has dementia, not be informed of her deterioration or death. Her brother strongly objects, saying their mother has a 'right to say goodbye'. What should you do?

Accepted Answer

Respect the patient's confidentiality and wishes

Answer

Inform the mother as she has a right to know about her daughter's condition

Answer

Support the brother to inform the mother as this is a family matter

Answer

Arrange a best interests meeting to decide what to tell the mother

Answer

Compromise by informing the mother only after the patient dies

Question 2

A 68-year-old woman with advanced ovarian cancer has capacity and refuses further chemotherapy. Her daughter, who has Lasting Power of Attorney for Property and Financial Affairs, insists that her mother continue treatment and threatens to sue if treatment is stopped. The patient remains adamant she wants to stop. What is the most appropriate course of action?

Accepted Answer

Respect the patient's decision and discontinue chemotherapy

Answer

Follow the daughter's wishes as she holds Lasting Power of Attorney

Answer

Apply to the Court of Protection for a decision

Answer

Continue chemotherapy until family consensus is reached

Answer

Refer to the hospital ethics committee for guidance

Question 3

A 54-year-old man with metastatic colorectal cancer and hepatic encephalopathy is admitted confused (MMSE 14/30). His wife produces a Lasting Power of Attorney for Health and Welfare document appointing her as his attorney, which was registered 2 years ago. She refuses palliative chemotherapy on his behalf, but his oncologist believes treatment would improve his quality of life and potentially extend survival. What factor should primarily guide the decision?

Accepted Answer

The patient's best interests, considering all relevant factors

Answer

The wife's decision as LPA attorney must be followed

Answer

The oncologist's clinical judgment about treatment benefits

Answer

The patient's previously expressed wishes about cancer treatment

Answer

A Court of Protection decision given the disagreement

Question 4

According to the Mental Capacity Act 2005, which of the following statements about the hierarchy of decision-makers for a patient lacking capacity is correct?

Accepted Answer

Valid advance decision to refuse treatment takes precedence over Lasting Power of Attorney for Health and Welfare

Answer

Court-appointed deputy takes precedence over a registered Lasting Power of Attorney

Answer

Lasting Power of Attorney for Health and Welfare takes precedence over advance decisions

Answer

Next of kin have legal authority to make treatment decisions if no LPA exists

Answer

Independent Mental Capacity Advocate can make binding treatment decisions

Question 5

A 71-year-old woman with metastatic lung cancer and capacity is receiving end-of-life care at home. Her pain is increasingly difficult to control and the palliative care team recommends a continuous subcutaneous infusion of diamorphine and midazolam. She agrees but says 'I don't want to become unconscious - I want to stay alert to talk to my family'. The doses proposed would likely cause significant sedation. How should this be managed?

Accepted Answer

Explain the likely effects of medication and explore her priorities regarding symptom control versus alertness

Answer

Start the infusion as planned - adequate pain control is the priority

Answer

Reduce the doses even if pain control is suboptimal to maintain alertness

Answer

Defer starting the infusion until she becomes less concerned about sedation

Answer

Start lower doses and increase without further discussion once she becomes too drowsy to participate

Question 6

A 37-year-old man with newly diagnosed HIV infection (CD4 250, undetectable viral load on treatment) works as a dentist. He has capacity and refuses to inform his employer or occupational health, citing concerns about discrimination. He follows standard infection control procedures. What is your professional obligation regarding disclosure?

Accepted Answer

You should maintain confidentiality as he poses minimal risk with standard precautions

Answer

You must immediately inform the General Dental Council

Answer

You must inform UK Health Security Agency who will inform his employer

Answer

You must inform his employer as patients have a right to know

Answer

You should seek advice from the GMC ethics department before taking any action

Question 7

A 56-year-old man with motor neurone disease attended his GP 6 months ago when mobile and made a written advance decision refusing 'ventilation of any kind' if he developed respiratory failure. He is now admitted with type 2 respiratory failure. He has lost speech but can communicate by eye movements. When asked about non-invasive ventilation (NIV), he consistently indicates he wants it. What is the legal status of his advance decision?

Accepted Answer

It is not applicable as his current wishes differ from the advance decision

Answer

It is valid and binding - NIV should not be started

Answer

It is not applicable as it was made more than 3 months ago

Answer

It is not valid as it was not registered with a solicitor

Answer

Court of Protection authorization is required to override the advance decision

Question 8

An 82-year-old woman with severe dementia (MMSE 6/30) and recurrent urosepsis is admitted from a nursing home. She has no advance decision or LPA. Her son (only relative) says 'Mum always said if she got dementia she wouldn't want to be kept alive with antibiotics'. There is no documented evidence of this. She appears comfortable but has sepsis requiring IV antibiotics. What weight should be given to the son's account?

Accepted Answer

It forms part of the best interests assessment but is not binding

Answer

No weight as there is no written advance decision to refuse treatment

Answer

It should be determinative as he is the next of kin

Answer

It constitutes a valid oral advance decision and antibiotics should be withheld

Answer

It should be ignored as the son may have ulterior motives

Question 9

A 16-year-old boy with a relapsed brain tumor refuses further chemotherapy, stating 'I've had enough - I want to enjoy what time I have left'. He clearly understands his prognosis and the consequences of refusing treatment. His parents, who have parental responsibility, want him to continue treatment and threaten legal action. Assessment confirms he is Gillick competent. What is the legal position?

Accepted Answer

Parental consent overrides his refusal for life-saving treatment in those under 18

Answer

His refusal must be respected as he is Gillick competent

Answer

Treatment must continue until he turns 18 and can legally refuse

Answer

The decision requires Court of Protection authorization

Answer

A best interests decision should be made by the clinical team

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